Sample Competency Assessment Tool

Transcription

1 Sample Competency Assessment Tool Introduction The first two pages of the Sample Competency Assessment Tool can be considered core competencies for the APP profession, and will apply to all PAs and NPs regardless of specialty. The third page is drawn from the specialty/department specific privileges granted; these vary widely by specialty and setting. The competencies selected are determined by the department/department chair and approved by the Medical staff. Additional Resources Appendix A: FPPE and OPPE Are More than Just Acronyms: But What Does It Mean to ME? PA Professional, December 00, by Tricia Marriott, PA-C, MPAS, DFAAPA Appendix B: PAs: Assessing Clinical Competence: Guide for regulators, hospitals, employers and third-party payers, AAPA, September 0 Websites: American Association of Nurse Practitioners: American Academy of PAs:

2 PA and NP Competency Measures Competency Measure Note: A score of or requires comments in the space provided Unacceptable Clearly inadequate; requires remediation Poor Many deficiencies Satisfactory Adequate Very Good Exceeds in many areas top 0% Excellent Superior in every way top 0% Patient Care (and Procedures) History taking: accurate and complete Physical exam: required components present Completes assessment and plans Provides quality patient education Competently performs medical and surgical procedures delineated by medical staff privileges-overall evaluation (See page for department specific privilege, focused evaluations.) Medical Knowledge Appropriate selection of diagnostic tests Appropriate interpretation/analysis of test results Appropriate integration of history and physical findings and diagnostic studies to formulate a differential diagnosis Overall integration of clinical information into treatment planning Pharmacological knowledge/ appropriate ordering of therapeutics Practice-Based Learning and Improvement Applies evidence-based medicine to clinical decisions Displays awareness of quality improvement measures and application to clinical practice Facilitates the learning of students and other health care professionals PA/NP Name: Date of Evaluation: 07 Center for Healthcare Leadership and Management

3 PA and NP Competency Measures Competency Measure Note: A score of or requires comments in the space provided Unacceptable Clearly inadequate; requires remediation Poor Many deficiencies Satisfactory Adequate Very Good Exceeds in many areas top 0% Excellent Superior in every way top 0% Professionalism Displays sensitivity and responsiveness to patients culture, age, gender, and disabilities Demonstrates understanding of the legal and regulatory requirements governing PA/NP practice and the role of the PA/NP Demonstrates commitment to personal excellence and ongoing professional development Interpersonal & Communication Skills Communicates effectively/behaves appropriately with patients Communicates effectively/behaves appropriately with physicians Demonstrates emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and anxiety Uses effective listening, nonverbal, explanatory, interviewing and writing skills to elicit and provide information Systems Based Practice Uses IT resources to support patient care decisions and patient education Practices cost-effective health care and resources allocation that does not compromise quality of care Applies medical information and clinical data systems to provide more effective, efficient patient care PA/NP Name: Date of Evaluation: 07 Center for Healthcare Leadership and Management

4 PA and NP Competency Measures Competency Measure - Orthopaedics Note: A score of or requires comments in the space provided Unacceptable Clearly inadequate; requires remediation Poor Many deficiencies Satisfactory Adequate Very Good Exceeds in many areas top 0% Excellent Superior in every way top 0% X-ray Interpretation: Demonstrates accurate interpretation of findings Provides complete documentation Fracture/dislocation reduction: Demonstrates appropriate technique Achieves acceptable alignment Provides appropriate post-reduction management/immobilization Cast/Splint Application: Demonstrates appropriate technique Applies appropriate splint type and selects appropriate materials Assistant at Surgery: Maintains sterile technique Demonstrates appropriate patient positioning/draping Provides effective retraction/exposure Demonstrates acceptable wound closure techniques, including approximation of layers, selection of closure material, and dressing application Medical Management: Antibiotics ordered appropriately ( hour prior to surgery, stopped in hours post-op, appropriate drug selected) DVT prophylaxis ordered appropriately Pain management appropriate PA/NP Name: Date of Evaluation: 07 Center for Healthcare Leadership and Management

5 PA and NP Competency Measures Evaluator Level of Interaction: Minimum: occasional encounters Moderate: weekly encounters Extensive: daily encounters Evaluator Physician (MD/DO) Peer (PA/NP) Comments: (Required for any Rating of or ) Evaluator Name: Evaluator Signature: PA/NP Name: Date of Evaluation: 07 Center for Healthcare Leadership and Management

6 PAYMENT MATTERS TRICIA MARRIOTT, PA-C, MPAS, DFAAPA FPPE and OPPE Are More than Just Acronyms But What Does It Mean to ME? IN THE VOCABULARY OF HOSPITAL MEDICINE, acronyms, abbreviations and initialisms are ubiquitous and well understood by PAs. When faced with the notation 7 y.o. w.m. w/hx/o IDDM, CHF, HTN, CAD and RA presents with CC/o CP and SOB, it s quite clear that a 7-year-old white male with a history of insulin-dependent diabetes mellitus, congestive heart failure, coronary artery disease and rheumatoid arthritis presents with chief complaint of chest pain and shortness of breath. Yet, many PAs are stumped by the acronyms FPPE and OPPE. Focused Professional Performance Evaluation, or FPPE, and Ongoing Professional Practice Evaluation, or OPPE, are Joint Commission standards from the Medical Staff chapter of the Comprehensive Accreditation Manual for Hospitals and Comprehensive Accreditation Manual for Critical Access Hospitals. FPPE and OPPE affect PAs and other practitioners who are credentialed and privileged through the medical staff process. A hospital s 8 PA PROFESSIONAL DECEMBER 00

7 FPPE and OPPE are each meant to establish the competence of the practitioner to perform the privileges granted in order to ensure the provision of safe and quality patient care. STEPHEN TRAVARCA failure to complete the FPPE/OPPE process might result in a Joint Commission citation. The Joint Commission has required hospitals to do FPPEs and OPPEs since 008, but hospital administrators and medical staff continue to struggle with these requirements. Credentialing refers to the process applied by hospitals to verify a practitioner s current licensure, relevant education and training, and competence to perform the privileges requested. Based on objective data, recommendations are made for granting or denying initial privileges, renewal of privileges or granting/denying new privileges. Once credentialing has been done, the privileging process can begin. There are three prongs to the privileging process: Requested privileges are approved based on criteria established by the medical staff; The medical staff s FPPE process ensures that the practitioner meets competence and organizational expectations for initial privileges; and the practitioner must meet ongoing performance expectations. FPPE and OPPE are each meant to establish the competence of the practitioner to perform the privileges granted in order to ensure the provision of safe and quality patient care. So let s commence with AAPA s FPPE/OPPE rundown: FPPE is defined by the Joint Commission as: the time-limited evaluation of practitioner competence in performing a specific privilege. This process is implemented for all initially requested privileges and whenever a question arises regarding a practitioner s ability to provide safe, high-quality patient care. FPPE criteria are defined by the medical staff to monitor the performance of the practitioner. The time limit is also determined by the medical staff. Once the FPPE period has been completed, OPPE begins. OPPE is a key component of determining practitioner competence for maintenance of clinical privileges. The ongoing assessment allows for identification of possible practice trends affecting patient safety. OPPE can also uncover opportunities for performance improvement activities. The Joint Commission defines ongoing professional practice evaluation as a document summary of ongoing data collected for the purpose of assessing a practitioner s clinical competence and professional behavior. The information gathered during this process is factored into decisions to maintain, revise, or revoke existing privilege(s) prior to or at the end of the two-year license and privilege renewal cycle. Data must be ongoing, so waiting for an annual review or the two-year recredentialing/reappointment process would not meet the standard. A PA s clinical privileges are determined and delegated by supervising physicians and are aligned with the physicians scope of practice. As such, OPPE criteria for PAs should be similar to those for physicians. AAPA s policy Competencies for the PA Profession references the ABMS/ ACGME six core competencies for physicians as a standard, and mirrors the concepts defined by the Joint Commission in the introduction to the OPPE standard:. Medical knowledge. Practice-based learning and improvement. Interpersonal and communications skills. Professionalism. Systems-based practice 6. Patient care Of note, ACGME and ABMS are updating the six core competencies for physician performance measurement, which they developed in 999. The competency previously known as patient care will be referred to as patient care and procedural skills. Procedural skills is categorized as a subset of the patient care core competency for which practitioners demonstrate proficiency. Defining criteria for performance measurement is one of the biggest challenges for organizations. Performance data are not readily extractable from many hospital computer systems, making data collection a manual process, which is labor intensive and time-consuming. Thus, organizations are looking to create an effective process, while facing enormous challenges within their own systems. The Joint Commission does not specify which criteria must be monitored. In fact, it states that the type of data to be collected is determined by the individual department and approved by the medical staff. Since OPPE data are used to determine maintenance of privileges, criteria should correlate with core competencies as well as the clinical privileges granted to the practitioner. Data used for the ongoing evaluation may be acquired via periodic chart review, direct observation, procedure logs, peer review, monitoring of diagnostic and treatment techniques, and input from other individuals involved in the care of the patient, such as other practitioners or administrative personnel. Quality measures from initiatives such as the Surgical Care Improvement Project, SCIP, or the Physician Quality Reporting Initiative, PQRI, are most likely already being collected by the hospital. The Health Information Management Department (aka Medical Records ) monitors chart completion delinquencies. Do Not Use abbreviations are also monitored. These data, already being collected, can also be applied to the OPPE process for each practitioner no need to invent new measures. Hospitals must find a way to share the practitioner-specific data with the appropriate department(s) responsible for OPPE. The ultimate goal of FPPE/OPPE is to ensure quality care and patient safety by monitoring the competence, activities and behavior of practitioners privileged to provide patient care. Joint Commission surveyors will be looking for documentation of the hospital s FPPE/OPPE processes and how they are applied to the credentialing and privileging process for its practitioners, including PAs. For more detailed information on FPPE, go the Joint Commission website, 9f6Hcl. OPPE detailed information is located at TRICIA MARRIOTT, PA-C, MPAS, DFAAPA, is AAPA s director of reimbursement advocacy and staff liaison to the Joint Commission. Contact her at tmarriott@aapa.org or , ext. 9. AAPA has created a sample, PA-specific, FPPE/ OPPE form. For more information on the form, contact Tricia Marriott at tmarriott@aapa.org. PA PROFESSIONAL DECEMBER

8 PAs: Assessing Clinical Competence Guide for regulators, hospitals, employers and third-party payers Physician assistants (PAs) are versatile members of the medical team, with broad, yet rigorous medical training. PAs practice in every medical and surgical specialty and every practice setting, providing a broad range of services that would otherwise be provided by physicians. They are graduates of accredited PA programs, licensed and nationally certified. PA education is a masters-level program modeled on physician education. Applicants must complete at least two years of college courses in basic and behavioral sciences as prerequisites. PA education programs average 6 months in length. The first year of PA school provides a broad grounding in medical principles and instruction in the classroom and lab. Year one consists of basic medical science courses, including anatomy, physiology, biochemistry, pharmacology, physical diagnosis, pathophysiology, microbiology, clinical laboratory sciences, behavioral sciences and medical ethics. In the second year, PA students receive hands-on clinical training through rotations that include family medicine, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine and psychiatry. PA students complete on average more than,000 hours of supervised clinical practice prior to graduation., There are more than 87 PA programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. Upon graduation from a physician assistant program, PAs must pass the Physician Assistant National Certifying Examination (PANCE), the initial certifying exam administered by National Commission on Certification of Physician Assistants. Starting in 0, NCCPA s Certification Maintenance requirements changed, with enhanced CME requirements and re-examination extended to a 0-year cycle, to mirror the Maintenance of Certification requirements for physicians. PAs will transition from a 6-year cycle to the 0-year cycle at their next recertification due date. While all states require initial certification for initial licensure, not all states require maintenance of current certification for licensure renewal. Credentialing PAs Organizations credential healthcare professionals to assure that patients receive high quality medical care. Hospitals, healthcare organizations, practices and third-party payers use varied systems for doing this. Many organizations adapt physician forms and criteria to create a parallel process for PAs. Unlike physicians, PAs do not have specialty board exams. They specialize by virtue of the physicians with whom they work. For PAs, primary sources include: State licensing board to confirm that the applicant is properly licensed Accredited PA program for graduation information National Commission on Certification of Physician Assistants (NCCPA) to confirm initial and ongoing national certification. Go to National Practitioner Data Bank (NPDB) for malpractice and adverse actions history

9 PAs: Assessing Clinical Competence The American Medical Association s (AMA) Physician Profile Service offers PA credentials verification. For a nominal fee, credentialing professionals can confirm a PA s education program attendance and graduation dates, national certification number and status, current and historical state licensure information, and AAPA membership status. The Joint Commission has deemed that the information provided by the AMA service is equivalent to primary source information PA Primary Source Verification State license Graduation from accredited program National certification NPDB/HIPDB check Similarly, the Federation of State Medical Boards offers its Federation Credential Verification Service to PAs. Privileging PAs in Hospitals Because of the breadth and rigor of PA education programs, students graduate with skills that are fundamental and essential to every specialty a fund of medical knowledge, interpersonal and communication skills, patient care-including the ability to provide age appropriate patient assessment, evaluation and management, professionalism, practice-based learning and improvement, and systems-based practice. PAs providing care in the hospital must be privileged through the Medical Staff process whether they are employed by the hospital or by an outside practice. 6 Core Privileges Some organizations identify core privileges that may be granted to any PA who meets the organization s criteria. Core privileges may vary depending upon the clinical department. They include, but are not limited to such things as performing histories and physicals; developing and implementing treatment plans; performing rounds; recording operative and procedure notes; recording progress notes; ordering and interpreting diagnostic laboratory tests and diagnostic imaging studies; ordering medications and writing prescriptions; managing fractures; suturing lacerations; performing corneal fluorescein exams and foreign body removal; providing anterior nasal packing for epistaxis; administering trigger point injections; incising and draining abscesses; and performing discharge summaries. This listing of PA core privileges is not meant to be exhaustive. There could be other core privileges, depending on the institution and department. Specialty Privileges PA medical education is broad. PA students master clinical fundamentals that prepare them to practice with physicians in virtually every area of medicine and surgery. However, unlike physicians, PAs do not have specialty board exams. They specialize by virtue of the physicians with whom they work. When PAs are evaluated for specialty privileges, hospitals can verify their competence through a number of means. Attestation to the PA s competence by physicians and PA peers Hospital systems that track clinical activity Data collected for initiatives such as the Surgical Care Improvement Project (SCIP) or the Physician Quality Reporting System (PQRS) Requiring a certain percentage of continuing medical education credits specific to the specialty

10 PAs: Assessing Clinical Competence Requiring maintenance of pertinent certifications such as Basic Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, Pediatric Advanced Life Support, etc. Certificates of completion from relevant clinical courses Use of simulation labs to assess cognitive and procedural competence Professional portfolio in which the PA documents procedures and patient care provided When a PA is a recent graduate or is changing specialties, it may be necessary to facilitate proctoring by a physician or senior PA until the PA requesting privileges can demonstrate competence. FPPE and OPPE Joint Commission accredited hospitals are required to include PAs in their focused professional practice evaluations (FPPE) and ongoing professional practice evaluations (OPPE), which are intended to help ensure the competence of providers. Data for the ongoing evaluation is acquired from periodic chart review, direct observation, procedures logs, peer review, monitoring of diagnostic and treatment techniques, and input from other individuals involved in the care of the same patients, including clinicians and administrators. Regulatory Agencies and Insurers State regulatory agencies and third-party insurance companies typically leave the determination of an individual PA s specialty and scope of practice up to the physicians with whom the PA works. This ranges from solo physicians, through large multi-specialty practices, to major health care systems. A PA working in a particular specialty has oversight and guidance by a physician in that specialty. Because the physicians and PAs work closely together, they are the individuals most able to determine the appropriate specifics of a PA s day-to-day practice, based on the PA s training and experience, patient needs and the needs of the particular practice. References. Physician Assistant Education Association. ( ). Twenty-fifth annual report on physician assistant educational programs in the United States. Alexandria, VA.. Association of Physician Assistant Programs. (99 99). Physician Assistant Education Programs in the United States. Washington, DC.. Accreditation Review Commission on Education for the Physician Assistant, Retrieved February, 08.. NCCPA: NEW CERTIFICATION PROCESS OVERVIEW Retrieved September, 0. Competencies for the Physician Assistant Profession (Originally adopted 00; revised 0) Definition-of-PA-Competencies-_-for-Publication.pdf 6. Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (AAPA Policy 0) Retrieved September, 0 TM 9/